Plastic and reconstructive surgery
-
Plast. Reconstr. Surg. · May 2013
Local anesthetics in liposuction: considerations for new practice advisory guidelines to improve patient safety.
The Practice Advisory on Liposuction published by the American Society of Plastic Surgeons provides a thorough review of anesthetic techniques and guidelines for surgeons who perform liposuction. However, there is evidence to support several changes to the anesthetic infiltrate guidelines that will improve patient safety. These proposed recommendations will have the most impact on patients undergoing office-based procedures, where dedicated anesthesia providers may not be present, but they should also guide practice in both ambulatory care centers and hospitals. The primary foci of the proposed changes include restrictions on bupivacaine use and creation of lidocaine concentration guidelines.
-
Plast. Reconstr. Surg. · May 2013
Clinical TrialPreexpanded perforator flaps of the dorsolateral trunk in pediatric patients.
Contractures and broad scars of the axilla, anterior chest wall, and neck have detrimental effects on functional, physical, and psychological development of children. Perforator flaps have already been shown to be reliable options for the reconstruction of contractures, but there have been no reports demonstrating the value of preexpanded perforator flaps of the dorsolateral trunk region in the treatment of extensive contractures and scars of pediatric patients. The purpose of this study was to demonstrate these techniques by a case series formed of pediatric patients with broad scars and contractures of the anterior chest wall, axilla, neck, and breasts. ⋯ : Therapeutic, IV.
-
Plast. Reconstr. Surg. · Apr 2013
Analysis of routine intensive care unit admission following fronto-orbital advancement for craniosynostosis.
Intensive care unit admission following fronto-orbital advancement for craniosynostosis is routine at most institutions. The authors determined the frequency of postoperative events requiring intensive care unit care that justify this practice. ⋯ In this study, 4.7 percent of patients had event/interventions requiring intensive care unit care after fronto-orbital advancement. Predictors included preexisting end-organ dysfunction and higher intraoperative blood loss requiring greater resuscitation. Financial savings from selective postoperative intensive care unit admission may not outweigh the potential cost of an emergent event on the surgical floor.
-
Plast. Reconstr. Surg. · Apr 2013
Resident involvement and plastic surgery outcomes: an analysis of 10,356 patients from the American College of Surgeons National Surgical Quality Improvement Program database.
Intraoperative experience is an essential component of surgical training. The impact of resident involvement in plastic surgery has not previously been studied on a large scale. ⋯ Residency has the dual mission of training future physicians and also providing critical support for academic medical centers. Using a large-scale, multicenter database, the authors were able to confirm that well-matched cohorts with-and without-resident presence had similar complication profiles. Moreover, even when residents were involved in comparably more complex cases with longer operative times, infection, graft and flap failure, and mortality remained similar.